Angiotensin-Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers in Older Patients with acute Myocardial Infarction after a Successful Stent Implantation

Abstract

Background: This study aimed to evaluate the long-term clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful stent implantation and were subsequently treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).

Methods: Among 13,104 patients enrolled in the Korean AMI registry, 2,763 older patients aged 70 years or older, who were prescribed either ACEI or ARB at discharge, were included in this study. Propensity score matching (PSM) was performed to adjust for baseline confounders. The primary outcome was a composite of cardiac death and recurrent myocardial infarction (MI) at the 3-year follow-up.

Results: In PSM cohort, use of ACEI at discharge was associated with a significantly lower incidence of primary outcome (hazard ratio, 1.60; 95% confidence interval, 1.20–2.14; p=0.001) compared to those of ARB at discharge. Additionally, incidences of cardiac death, recurrent MI and all-cause death were lower in use of ACEI at discharge than in those of ARB. However, there were no statistically significant differences between the two groups in hospitalization for heart failure, any revascularization, stent thrombosis, or stroke.

Conclusion: The findings of this study suggest that ACEI use at discharge, compared with ARB use, was associated with lower incidences of cardiac death, and recurrent MI in older patients with AMI after successful stent implantation.